Credit Refund Specialist - Remote
The University of California, San Diego
About this position
Position Description
UC San Diego Health's Revenue Cycle department supports the organization’s mission to deliver outstanding patient care and create a healthier world — one life at a time. We are a diverse, patient-focused, high-performing team committed to quality, collaboration, compliance, and continuous improvement. We offer challenging career opportunities in a fast-paced and innovative environment and welcome individuals who demonstrate strong problem-solving skills, accountability, accuracy, and customer service. The Credit Refund Specialist is responsible for researching, validating, and resolving hospital credit balance accounts, insurance refund requests, overpayments, payer recoupments, and related account adjustments. This position requires strong hospital/facility billing knowledge, critical thinking, attention to detail, and the ability to determine whether a refund is appropriate based on claim history, payment activity, payer correspondence, contract terms, adjustment activity, and applicable state and federal requirements. This role supports accurate reimbursement, appropriate account resolution, compliance with refund processing standards, and timely communication with payers and internal departments. The position requires sound judgment to identify unsupported or unclear refund requests, escalate complex accounts when needed, and ensure refunds are processed accurately and compliantly. Key Responsibilities: Analyze hospital insurance credit balance accounts to ensure timely identification, validation, resolution, and issuance of accurate refunds when appropriate. Review insurance refund requests, payer correspondence, remittance activity, claim history, adjustments, and payment activity to determine whether a refund is supported. Review and interpret hospital payer contracts and reimbursement methodologies to verify expected reimbursement and identify discrepancies such as overpayments, underpayments, duplicate payments, or incorrect payer calculations. Research and resolve account credit balances related to coordination of benefits, retroactive eligibility changes, payer recoupments, duplicate payments, contract adjustments, payment posting discrepancies, and billing corrections. Respond professionally and effectively to inquiries from payers and internal departments regarding account balances, refund statuses, payment activity, and account resolution. Process insurance refund requests accurately and compliantly according to payer requirements, organizational standards, and applicable state and federal regulations. Identify, analyze, and resolve billing discrepancies, claim errors, payment variances, and account issues related to credit balances and refunds. Collaborate with internal teams, including billing, denials, payment posting, revenue integrity, contracting, coding, and patient access, to support accurate reimbursement and account reconciliation. Maintain clear, accurate, and compliant account documentation supporting refund decisions, account actions, and escalation outcomes. Maintain compliance with HIPAA regulations and ensure confidentiality and security of patient information throughout the refund and credit balance process.
Qualifications
Three (3) years of acute care hospital billing, collections, payer follow-up, credit balance, refund, or account resolution experience. State and Federal rules and regulations related to facility medical insurance billing, claim processing, and refund handling. Demonstrated knowledge reviewing and resolving hospital claim errors, payment discrepancies, account balances, and payer correspondence. Thorough knowledge of UB04 and revenue codes as it pertains to hospital billing and reimbursement. Extensive knowledge in submission of hospital claims appeals and basic knowledge in medical terminology, ICD9, CPT, HCPCS coding principles. Demonstrated knowledge of facility reimbursement contracts and reimbursement methodologies including but not limited to per diem, fee schedule, case rate and DRG's. Demonstrated knowledge reviewing/processing facility insurance refund requests and account credit balances.